Provider Demographics
NPI:1144609066
Name:BOSH, SARA
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:BOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18231 CIVIC PARK DR UNIT 2362
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-9315
Mailing Address - Country:US
Mailing Address - Phone:734-308-6818
Mailing Address - Fax:
Practice Address - Street 1:18231 CIVIC PARK DR UNIT 2362
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-9315
Practice Address - Country:US
Practice Address - Phone:734-308-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010969791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801096979OtherLICENSE